Table 1 Characteristics of electronic audit and feedback interventions identified by the review
Study ID | Linder et al. 2010 [38] | Thomas et al. 2007 [39] | Carlhed et al. 2006 [34] | Guldberg et al. 2011 [36] | Gude et al. 2016 [35] | ||
|---|---|---|---|---|---|---|---|
Study design | CRCT | CRCT | CRCT | RCT | RCT | CRCT | CRCT |
A&F domain | Prescribing and management of drugs, acute care management | Prescribing and management of drugs, guide primary prevention and screening | Chronic disease management | Guide primary prevention and screening | Acute care management | Chronic disease management | Chronic care management |
Feedback recipients | Physicians | Physicians | Physicians | Physicians | Interdisciplinary clinical teams | Interdisciplinary clinical teams | Interdisciplinary clinical teams |
Direction of change required | Reduce current behaviour | Increase current behaviour | Unclear | Reduce current behaviour | Increase current behaviour | Increase current behaviour | Increase current behaviour |
A&F implementation | EHR-integrated tools | Web panel screens | Software panel screens | Web panel screens | Web panel screens | Distributed as software update | Web panel screens |
Interactive A&F component | Drill down to patient level; select indicators for feedback | Drill down to patient level; select indicators for feedback | Choose presentation mode | Select indicators for feedback | Select indicators for feedback | Drill down to patient level; select indicators for feedback | Select indicators for action plan |
Feedback presentation mode | Graphical summaries | Graphical summaries | Text summaries | Unclear | Graphical summaries | Tabular data, graphical summaries | List summaries, with ‘traffic light’ icons |
Frequency of feedback updates | Monthly (automatically) | Bi-monthly (automatically) | Bi-monthly (automatically) | Every login | Real-time | 3 times (month 1, month 3, month 12) during the trial by software update | Quarterly |
Target goals basis | National CDC recommendations | Australian medical guideline recommendations | National evidence-based guideline recommendations | Radiologist defined their own goals | National evidence-based guideline recommendations | National evidence-based guideline recommendations | National evidence-based guideline recommendations |
Action planning used | No | No | No | Yes | Yes | No | Yes |
Benchmarks and comparators | Clinician vs peer average performance vs national benchmark (identified through expert analysis) | Peer-ranked performance data benchmarked against participating trial sites | Clinician vs aggregate average resident performance (based on Institute for clinical systems improvement targets) | Radiologist performance vs trial peers’ performance vs achievable national benchmarks | Local team vs average trial peers’ performance; local team vs national average performance | Local practice performance vs average performance of trial peers | Local team-based performance vs. peer performance (calculated as achievable benchmarks) |
Intervention duration (months) | 9 | 12 | 12 | 21 | 18 | 14 | 19.8 and 22.5a |
Participants in study (n) | Primary care practices (27) | Primary healthcare centres (60) | Clinical groups (residents) within hospital | Clinical groups (radiologists) between regional hospitals | Multi-disciplinary teams between hospitals (38) | General practices (86) | Cardiac rehabilitation Centres (18) |
Outcome type | Dichotomous process measures | Dichotomous process measures | Dichotomous process measures | Dichotomous process measures | Dichotomous process measures | Dichotomous process measures | Dichotomous process measures and patient outcomes |
Comparator arm | A&F vs current practice | A&F vs current practice | A&F vs current practice | A&F vs current practice | Head-to-head comparison of A&F | A&F vs current practice | Head-to-head comparison of A&F |
Role of e-A&F in overall QI strategyb | Core | Moderate | Minimal | Core | Moderate | Core | Core |
Baseline performance known | Unclear | Yes | Yes | Yes | Yes | Yes | Yes |
Risk of bias | Medium | Low | Medium | Unclear | High | Medium | Low |